254 thoughts on “Spinal Fusion: Chiropractic and Subluxation”

So, the executive summary of these over 200 comments regarding chiropractic and its core legal definition and belief system is:

1. Many subjective symptoms related by humans are caused by subluxations or spinal dysfunction or a manipulable lesions or some similar term, but many chiropractors don’t really believe that and none has ever been demonstrated or imaged in over 116 years. This diagnosis can only be detected and localized by chiropractors and vanishes after the exam since the diagnosis and treatment are simultaneous. The public continues to be told they have a “bone out of place” or a subluxation or some such and that following the spine manipulation, whether there is an audible “pop” from nitrogen gas going out of solution due to negative pressure in the joint (especially neck cracking), or not, the patient is told “it has been put back”…or that “it is back in”. Many patients due to the clinical encounter or placebo effect or what have you, say they this makes them feel better.
2. Some chiropractors treat ear infections, bed wetting, high blood pressure, headaches, constipation, and other medical problems with the assumption they are helping in some way.
3. Some chiropractors advise treating children and basically everyone with “maintenance” spinal manipulations for spinal health.
4. Complications of the above would seem to include:
a. There is no science behind either the diagnosis or treatment.
b. There are, fortunately highly infrequently, vertebral artery dissections leading to stroke and sometimes death from cervical manipulation. Temporary neck pain and discomfort occurs in about 1/3 of instances.
c. Much delay of proper and effective diagnosis and treatment occurs, due to gullible public embarking on a cult approach to symptom relief.
d. Much waste of money occurs as self-limited conditions are treated as if there were some spinal dysfunction.
5. As long as the core belief and message to the public that spinal dysfunction is ubiquitous and that a bone out of place needs to be manipulated back into place, persists, progress worldwide by chiropractic cannot occur.

Well, #1 is somewhat true but to less and less an extent by fewer and fewer chiro’s. #2 is still occasionally true but is not consistent with the legal scope of practice and could be reported if you have some evidence of it actually occurring. #3 is also still true although I am not seeing a true problem with it, #4a is not true. #4b is exaggerated and has been discussed at length on this website based upon research that even the leaders here on this website have finally, after much debate and discussion in the past, fessed up to. (You can do your own reading of the past threads. I’ll not rehash it again.) #4c does not occur at a “much” rate as your bias would indicate. Its statements such as this that reveal your bias. #4d is goofy. To imply that only chiro’s treat self-limiting conditions is absurd. Additionally, there is no way to know if a condition treated, would have been self-limiting in any case. It can be implied but not proven. If such is the case then we all need to close our doors, both chiro’s and PCP’s. #5 I would agree if it actually were the core belief, but despite what the colleges allegedly purport, it simply ain’t true in the majority of the profession.

you said “Maybe I should be more clear; you are not directly palpating anterior vertebral bodies (or upper posterior ribs). You are palpating the tissues above them in a fashion similar to a masseuse; claiming anything else is a delusion.”

LMAO, nice backpedal and adding the word directly to your weak argument. Obviously, I am not DIRECTLY palpating these muscles. I can’t even imagine anybody thinking I was. Have you heard of the organ called skin which would keep you from DIRECTLY palpating almost any structure? And no, I am not just palpating the superficial structures I am palpating through (via compression) these structures as I said before. Have you ever done an abdominal exam in which you palpate the liver and kidneys? Oh wait your not actually palpating the liver and kidneys your palpating the skin and muscles above them!

Semantics aside, your hypothesis is idiotic. If it were even remotely true I’d be able to remove the scar tissue on the back of my hand (from an old football injury) by simply rubbing it away. Well, I’ve been doing that for ~10 years and, guess what, its still sitting there. Actually, if you could just massage away scar tissue why can’t you do it for any organ?

It is not just rubbing or massage. You must shorten the structure, add tension and slight compression and then fully lengthen the structure. If your scar is not raised it would be difficult to produce tension. This is a major reason why you can not remove scar tissue from other ogans via myofascial release (ie. no producible tension).

And if you aren’t removing it where does it go? Dissolve into the subcutaneous tissue?

Have you heard of phagocytosis?

And the study you cited sucks; it is 20+ years old (old enough that I can’t get anything more than the abstract through my university) and the authors admit in the abstract that it doesn’t answer the question about interobserver reliability

The design of marcus and your study is flawed as well. You want clinicians to make a diagnosis without taking a history. Sounds unethical and illegal to me.

Fair enough, the wording came out poorly. But, really, if I “compressed” hard enough I could probably “palpate” the caudate. Again, if you are really digging at someone’s neck hard enough to “palpate” anterior vertebral bodies (something both I and an orthopod think is delusional) it is probably tantamount to assault but more likely a delusion on your part.

“It is not just rubbing or massage. You must shorten the structure, add tension and slight compression and then fully lengthen the structure. If your scar is not raised it would be difficult to produce tension. This is a major reason why you can not remove scar tissue from other ogans via myofascial release (ie. no producible tension).”

Huh? That might sound impressive to a layperson but if you really think about it, that is exactly what a masseuse does. I bet it feels good but that doesn’t qualify it as medically useful therapy.

You’re going to have a hell of a time showing how massage therapy somehow modulates phagocytosis.

I don’t think you understand what we’re asking for. Take our symptomatic and asymptomatic patients and see if the chiropractors can agree on who (and where) the “subluxations” are occurring. Uncomplicated LBP isn’t exactly a crisis and the ones that are actually having pain can get some Tylenol and a nice back crack/massage afterwards. Not gonna kill ‘em and it would be extremely informative about the reliability (or lack thereof) of a chiropractor’s diagnosis. I think chiropractor’s are afraid to do this because, if they took a random sampling of DCs, a bunch of them would diagnose “subluxation” in asymptomatic people.

“I don’t think you understand what we’re asking for. Take our symptomatic and asymptomatic patients and see if the chiropractors can agree on who (and where) the “subluxations” are occurring. Uncomplicated LBP isn’t exactly a crisis and the ones that are actually having pain can get some Tylenol and a nice back crack/massage afterwards. Not gonna kill ‘em and it would be extremely informative about the reliability (or lack thereof) of a chiropractor’s diagnosis. I think chiropractor’s are afraid to do this because, if they took a random sampling of DCs, a bunch of them would diagnose “subluxation” in asymptomatic people.”

My point is that pain/tenderness is a major diagnostic indicator of joint dysfunction and if the chiro is blinded to this information then he/she will not be able to reliably diagnose joint dysfunction. I would like to see the same study done with PCP MD’s and see what their diagnosis would be without being able to ask historical quesitons.

“Huh? That might sound impressive to a layperson but if you really think about it, that is exactly what a masseuse does. I bet it feels good but that doesn’t qualify it as medically useful therapy.”

To my knowledge most massage therapist do not have you actively shortening and lengthening muscles while they (massage therapist) are applying tension. It is usually a passive treatment and in general much less specific.

“My point is that pain/tenderness is a major diagnostic indicator of joint dysfunction and if the chiro is blinded to this information then he/she will not be able to reliably diagnose joint dysfunction. I would like to see the same study done with PCP MD’s and see what their diagnosis would be without being able to ask historical quesitons.”

I betcha we could find plenty of chiropractors that would be willing to “joint dysfunction” (subluxation) without getting a history. In fact, given the numbers that still believe in subluxation (see Jan’s original article), it would be a vast majority.

As for myofascial release, still sounds like glorified massage to me. And it would be interesting how massage is somehow “less specific”.

Cowy1 said: I betcha we could find plenty of chiropractors that would be willing to “joint dysfunction” (subluxation) without getting a history.

Maybe, but I think you would have much more trouble than you think finding them especially if we are talking about in office as opposed to the sidelines of sporting events where a much more focused history would suffice.

you also said:”In fact, given the numbers that still believe in subluxation (see Jan’s original article), it would be a vast majority.”

I discussed this earlier so I will be brief. In short, she found the word subluxation used in college catalogs and took this to mean that the history of how a subluxation was thought to effect the body was taught. When, in fact, all this (subluxation) means is joint dysfunction. The ACA defines subluxation as a motion segment, in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact. See my first couple posts on this thread for more info.

“As for myofascial release, still sounds like glorified massage to me. And it would be interesting how massage is somehow “less specific”.”

In general massage is used to relax hypertonic muscles and myofascial release is designed to remove a specific pathology (adhesion/scar tissue) from or between soft tissue structures.

OK, so now we have it. Chiropractic started 116 years ago as an observation that some people seemed subjectively improved by having personal attention and their spines twisted. Since then, there grew an enormous house of cards around the concept os subluxations and bone out of place and “hole in one” along with some stuff about holistic this and that, energy, vitalism, etc. and now there is admission that the subluxation diagnosis is just a fiction meaning the patient had some symptom or tenderness in a location which was then identified as being the cause of a subluxation or manipulable lesion or motion disfunction, or some other name. This is about the same as MDs saying low back pain is due to a back strain or if it is one-sided, that it is due to a “facet syndrome”. UNC rheumatologist Nortin Hadler prefers the term “regional back pain” implying the condition is self limited and 95% or more improve on their own. Chiropractors prefer to manipulate the spine to treat such and there is some evidence patients often prefer to do something like that intervention rather than wait it out. And that is the sum of the science of chiropractic.

Now to the myofascial release, it is a fiction whether done by chiropractors or PT. As to the history taking by chiropractors, I can relate multiple instances where the patient complained of tailbone or shoulder pain or headaches and had their necks twisted, presumably because the chiropractor was trained in the “hole in one” theory that all vital forces flow through the foramen magnum and thus neck cracking is the treatment for everything. Some of those patients (fortunately this is a relatively rare occurrence, one in thousands of neck crackings) lost their lives or had permanent neurologic injury due to vertebral artery dissection and stroke. Unfortunately, chiropractors still refuse to admit the neck cracking is dangerous. The victims (again, a rare occurrence, but with millions of neck crackings done annually …the patient whose neck was cracked for treatment of coccydynia had been manipulated over 150 times before she stroked on the chiropractic table and died) pay a high price for their treatment by a method with no evidence based medical effectiveness.

Well, #1 is somewhat true but to less and less an extent by fewer and fewer chiro’s. #2 is still occasionally true but is not consistent with the legal scope of practice and could be reported if you have some evidence of it actually occurring.

Well, let’s do a quick check into that. Let’s note up front that this approach is very far from comprehensive, and is subject to potential bias, but a very basic investigation may be had by Googling for chiropractors in a city (I’ll do Boston since that’s where I am) and seeing what their webpages say. For, say, the top 5 hits.

1. Has a “would you benefit” page which lists symptoms and the vertebrae with which they are purportedly associated. In just the first 5 we have vision problems, ear infections, allergies, fainting, acne, eczema, hay fever, hearing loss, laryngitis, sore throat, and hoarseness. Definite #2. “About chiropractic” states “Chiropractic is used to correct vertebral subluxations, also referred to as nerve interference, in a safe and effective manner.” So definite #1 as well. Not an auspicious start.

2. Offers acupuncture and TCM, so clearly not science-based, but that’s not directly addressed to the points in question. States that “Chiropractic is a health care approach and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system” which is effectively subluxations without using the term. Also says “Additionally, people with asthma, high blood pressure, or PMS could also benefit. Recent falls or other injuries may heal faster with the help of a chiropractor as well.” So here also we have clear #1 and #2.

3. “What are subluxations? — A subluxation is the result of spinal bones with improper motion or position affecting nerve communications between your brain and your body.” So yep, subluxation-based again. “Why patients see us” includes ADHD, allergies, asthma, bed wetting, colic, ear infections, and that’s just in the first third of the list. A pattern is emerging here.

4. “We may help you with” allergies, asthma, bed wetting, ear infections, etc. “What is chiropractic” states that “What truly differentiates doctors of chiropractic from any other healthcare professionals is the fact that chiropractors are the only professionals who are trained to diagnose and treat what are called spinal subluxations.” Yep, the pattern continues.

One could speculate that it might be that those chiropractors who embrace subluxations and believe they can treat a wide range of conditions are more likely to have websites, and/or those websites are more likely to be highly ranked in Google. This would be one of those possible biases I mentioned.

Suppose that one is a patient looking for chiropractic care. These days, what will likely be the first thing you do? Google for a chiropractor in your area, that’s what. So even if this is a non-representative sample, it’s the non-representative sample to which patients are most likely to gravitate. It is therefore inappropriate to claim that this represents a minority and hence is not an issue. That would merely adjust what TYPE of issue it is.

Well, I gave it a fair shot, and I am unimpressed by the new chiropractic (if myofascial release is anything to judge it by). I looked for fully-viewable papers in pubmed (mixed results). I also looked at the Wikipedia page for it, and it looks like myofascial release itself might have some historical weirdness to cut out (something about the procedure on one muscle fixing the whole system?).

My point is that pain/tenderness is a major diagnostic indicator of joint dysfunction and if the chiro is blinded to this information then he/she will not be able to reliably diagnose joint dysfunction.

Nobody is saying you should be blinded to that. You should be blinded before hand knowing which patients have the chronic LBP. Try and elicit the responses yourselves, assess the dysfunction, say exactly where it is, and go from there. No two chiros will agree. That is the point.

To my knowledge most massage therapist do not have you actively shortening and lengthening muscles while they (massage therapist) are applying tension. It is usually a passive treatment and in general much less specific.

I love massages. Get them anytime time I can. A masseuse pushes on my muscles and rubs hard up and down along them. Then (s)he will squeeze them and even apply a sort of pinching motion from time to time. How is that not “actively shortening and lengthening muscles?” Passively doing so means the patient is moving their own muscles to lengthen and shorten. I don’t know how you get massages, but I just lay there and relax and let the massuese do all the work.

This myofascial “active lengthening and shortening” makes absolutely no sense. Neither does you “ever heard of phagocytosis” comment. Are you trying to say that you are breaking up the fibrotic tissue and inducing a hyperemic state to get the phagocytes to eat the tissue? What would prevent that from forming a bigger scar, y’know, considering that it was tissue disruption and a hyperemic state that produced that scar in the first place?

Seriously – and you wonder why we scoff. These explanations are all handwaving and completely incongruent with reality.

@nybgrus: You are hopelessly Newtonian, logical and pre-post-paradigmatic shift-based conventionally bioallopathic in your thinking. Don’t you know that postmodern, post-subluxatory chiropractic deconstructs and transcends the Cartesian metaphysical distinctions between humankind and spinal realities, observer and observed, Subject and Object, massaged and palpated, cash and credit?

In support of this, and according to London-based lifestyle guru Edwina “Eddie” Monsoon, you should give up this outmoded medicine and concentrate on aromatherapy, transgressive psychotherapy, reflexology, bioenergetic osteopathy, homeopathy, naturopathy, crystal reading, shiatsu, and reiki. And of course get a totally organic hairdresser and see if you can be re-birthed next Thursday afternoon.

You misquoted me and I don’t appreciate it. Please refrain from doing it again.

@nybrguys

“Nobody is saying you should be blinded to that. You should be blinded before hand knowing which patients have the chronic LBP. Try and elicit the responses yourselves, assess the dysfunction, say exactly where it is, and go from there. No two chiros will agree. That is the point.”

Again, a false statement and no citation of course. I have already posted studies which shows good agreement between different practitioners when assessing painful joint dysfunction.

@marcus

“Chiropractors prefer to manipulate the spine to treat such and there is some evidence patients often prefer to do something like that intervention rather than wait it out. And that is the sum of the science of chiropractic.”

At this point you’re choosing to be deliberately ignorant. We’re all aware of mechanical low back pain diagnosis. DCs simply focus to focus on the biomechanics of it, manually. What is your management for MLBP?

NMS-DC

PS: Asymptomatic doesn’t mean functional. Many people don’t have symptoms of hypertension, that doesn’t mean it shouldn’t be addressed.

Another bold face lie. Dr. Welby you can’t just ignore evidence that you personally disagree with. No evidence behind the effectiveness of SMT for back, neck and headache? If you are stating this, you are not evidence-based.

b. There are, fortunately highly infrequently, vertebral artery dissections leading to stroke and sometimes death from cervical manipulation. Temporary neck pain and discomfort occurs in about 1/3 of instances.

Citation? There are many complications as well for treatment of headache and neck pain by medicine. NSAIDs, unncecessary surgeries, addiction, etc. All treatments, used inappropriately, can be bad for the patient.

c. Much delay of proper and effective diagnosis and treatment occurs, due to gullible public embarking on a cult approach to symptom relief.

It has been demonstrated time and time again, in this thread that MDs are terrible at MSK and consequently misdiagnose and over prescribe, including wasting money with tons of MRIs that aren’t necessary and lead to more surgery for red herrings.

d. Much waste of money occurs as self-limited conditions are treated as if there were some spinal dysfunction.

Self-limiting, but recurrent. If you don’t treat the underlying mechanical dysfunction (all of it, not just the joint with SMT/mob) the muscle imbalance and faulty motor programming will persist. It’s worth fixing.

5. As long as the core belief and message to the public that spinal dysfunction is ubiquitous and that a bone out of place needs to be manipulated back into place, persists, progress worldwide by chiropractic cannot occur.

BOOP has not been a theory of chiropractic since the 1930s. Yet you’re talking about something that is over 80 years and not even true. Deliberate attempt to confuse or outright lie. Sorry Dr. Welby, you don’t get to make up science and stories because you’re an MD. We all play by the same rules in the EBM era.

It sounds like you are talking to yourself NMS-DC. Literally every single thing you accuse us of doing is precisely what you have been doing. But that is very common in pseudoscientific and ideological beliefs. Theists call atheism “just another religion.” Creationists claim that “evilutionists” are ignoring the massive pile of evidence for creationism and pandering a dogma instead of a science. Young earther’s have museums and “scientists” to demonstrate that the grand canyon was formed in a single go from the great flood, and then say we are all blind to the evidence they have presented.

Sorry NMS-DC, but stand in front of a mirror and read what you have written. At least then you will be on target and accurate for once.

Let’s talk about trends, BW, if you’ll indulge me. Is the trend towards EBM chiropractic or subluxation-based chiropractic, in terms of education and research. These are relevant matters to our conversation. Please provide citations for your answer as like Harriett said, anecdotes are worthless here.

Name me 1 pseudoscientific belief I have espoused here. Creationists, religion, atheism? What are you talking about? We are talking three key points (let me remind you again)

1) DCs are valid health practitioners for MSK which is the majority of conditions they treat
2) There is substantial evidence and scientific research into SMT and it has been found to be effective for low back, neck and headaches, as well as nascent evidence for maintenance SMT for chronic LBP
3) There is valid scientific research being conducted by chiropractic scientists and chiropractic schools.

I’ve proven these points over and over again. The rebuttals that the “experts” here keep bringing up (with no citations of course)

1) SMT is placebo based
2) MSK disorders aren’t a big deal and not worthy of a 4 year degree
3) joint dysfunction doesn’t exist
4) outright refusal to acknowledge there is a chiropractic science despite the overwhelming evidence that it is a real, developing field.

But that’s OK. I’ve read all the comments are and I was hoping to see some truly insightful questions that I couldn’t easily find a citation to rebutt. You’re all rehashing the same arguments, but defend PT and MD and DO who practice the same way DCs do. Hey, newflash! The AMA lost in 1987. Many of you thought that chiropractic was a cult with 0 skills whatsoever and I’ve proven that view to be dated, at the very least. I’m looking forward to Jann’s next post on chiropractic. At least he tries to cite evidence. Dr. Gorski’s physician thread is not something I’m going to participate in as I have already expressed my personal opinion on the PCP subject and the laws outside the US are clear on this as well as being primary contact/portal of entry. DCs are more like DDSs than MDs. Most would agree with that assertion that it is a specialty.

So the idea is that we should leave all those other schools to do whatever they want, but then have the “new schools” somehow still produce people with the same title under the same accreditation and licenses and that be the answer? You’re seriously bent.

Your analogies are terrible because they’re comparing apples to oranges and are not relevant to our discussion and is again, more white noise.

You defended MDs, PTs and DOs performing spinal manipulation. That is practicing like a chiro. Don’t forget DCs do 90% of all SMTs. Can’t have it both ways.

“All the other schools” The licenses are jurisdiction specific. Laws in Canada differ than US, UK, France, etc. Like a typical myopic American, you’re unable to see past yourself. I have and always have been referring to international chiropractic practices and standards. I’m glad you have a problem with straight/subluxation-based schools. We’re on the same page. My point was is that they are in the process of being diluted by schools that are either already EBM or heading in that direction. Don’t forget they are the minority, and overwhelmingly so.

Well hey, its not like there are any standards. A chiropractor or the school (or naturopath or acupuncturist) can claim pretty much anything he wants and its not like the licensing boards or accrediting bodies are going to do or say anything about it.

Actually, rereading the original article, Jann pretty much took a dump on the notion that subluxation as the major cause of disease is simply a historical artifact. First section, apparently over 75% of practicing DCs believe that the subluxation is a major contributor to visceral disease. I also tried what Scott did, but this time for Chicago. I went through 3 pages of Google after searching for “Chicago Chiropractor”. Couldn’t find a single one that didn’t mention either subluxation as a major cause of disease or that vigorous, twice-weekly back cracking will somehow improve nervous system communication with the rest of the body.

BOOP? Maybe not but then again, for the majority of chiropracty, it looks like it could still be 1895.

I don’t feed trolls. And relying on google search for evidence? Find some stuff on PubMed. And then we’ll talk about the elephant in the room, i.e. all your arguments are the same, come from the same source yet you never mention him. Why?

The vast majority of DCs are in the United States. And, like Jann’s article suggested, most of the school are hives of vitalistic quackery. Check out NUHS’ website; the supposed research arm of the profession openly embraces rank quackery like homeopathy and naturopathy. Not good signs. It gets even more fun if you go to Palmer or Logan’s websites.

I have seen the light! Do you think Bastyr will accept my credits from my first two years of allopathic (frowny face) med school?

Only if you (a) promise to relegate all you’ve learned to the sharps bin of history, (b) promise never to mention your past dabbling in the biopharma arts on campus and (c) promise never, ever to laugh out loud when you read on their school website that its founder “Dr. Bastyr was the type of teacher who mystified his students….”

I love massages. Get them anytime time I can. A masseuse pushes on my muscles and rubs hard up and down along them. Then (s)he will squeeze them and even apply a sort of pinching motion from time to time. How is that not “actively shortening and lengthening muscles?” Passively doing so means the patient is moving their own muscles to lengthen and shorten. I don’t know how you get massages, but I just lay there and relax and let the massuese do all the work.

I think you have your definitions screwed up here. When discussing active and passive you are talking about the patient not the practicioner. To actively shorten and lengthen muscles the patient is actively perfroming the motion and passively means the practicioner is perfroming the motion. Just think of active range of motion testing (ie. the patient moves through range of motion).

No, you haven’t produced one scientific article with any of your statements. Your attempt at humor went over like a lead balloon. The only thing that is inflated here are certain MD students egos…

All the arguments coming from the skeptics come from the same source, used very similar and phrasing as the self-described “world’s first professor in complementary and alternative medicine”. Pmoran words mimic his to a T. I’ll give you a hint. E_z_rd _rnst. You heard of him SBM?

Nybrygus doesn’t even know the proper definitions of passive and active ROM. Like I proved earlier in this thread, MDs and MD students are terrible at MSK. It’s like taking candy from a baby at times around here. That’s why I want to debate a physiatrist, sports MD or the legendary Dr. Sam Homola. At least they should be up on their MSK.

The fact that they don’t even understand the concept of tissue remodelling is more proof how they just don’t get basic science of MSK medicine and, by extension, chiropractic science. Notice not 1 SBM MD poster has disagreed with my statement that the MDs are woefully and inadequately trained in MSK diagnosis. Hard to be a “good” PCP if you don’t know the basics in terms of orthopedic exam and DDx for MSK.

you are correct, I did stuff that one up. mea culpa. I can claim jet lag, but hey, everyone makes mistakes. I’m happy to fess up to mine.

Still doesn’t address any of the salient points. Funny how only the chiros seem to think they are making any sort of sense. Every med student, physician, nutritional scientist, orthopod, and non-medical person here has a different opinion.

I’m starting to believe you guys geniunely believe the stupidity you are all spouting. I know – it should be obvious, but really I have a hard time believing people can genuinely be so incredibly blind.

@cowy: I guess New Orleans is slightly less woo-ful than Chicago or Boston. The second entry I found actually had a chiro who “Using skilled chiropractic adjustments to restore joint movement, balance/relax musculature, and reduce pain. Dr. Thompson specializes in the treatment of acute and chronic neuro-musculo-skeletal related issues.”

I do find it thoroughly entertaining that after completely denying every bit of evidence in Jann’s article and doing a couple changing of the goal posts and a Gish-Gallop or two a la creationists, they fail to see the point of a google search. Like somehow it is just so completely irrelevant to the discussion…. although that makes sense, since they are having a discussion with themselves alone, with utter disregard for actual science and clinical medicine.

By the way, I’ll trade you some brunette pharma reps for some of your blondes. I’m getting a little tired of dark haired beauties telling me how to maximize my prescriptions. Makes me want a sertraline.

oh, and I guess since NMS-DC specifically raised the point, I will actually say that indeed, MDs are good at detecting and treating MSK issues. Well, assuming they are of a speciality that even deals with that. I don’t imagine a cardiologist or nephrologist would be very good at it.

All the arguments coming from the skeptics come from the same source, used very similar and phrasing as the self-described “world’s first professor in complementary and alternative medicine”. Pmoran words mimic his to a T. I’ll give you a hint. E_z_rd _rnst. You heard of him SBM?

A weird attempt to discredit by association.

If you want to dispute anything I have said, let’s be having you. I am, as I am sure you already know, fully prepared to argue out the evidence with no assistance from anyone, and certainly without referring to external authorities, as is your wont.

NMS-DC wrote on 15 November 2011 at 03:33:38: “Is the NZ a new school.”

I don’t know, but what I do know is that it’s still steeped in quackery.

NMS-DC wrote on 15 November 2011 at 03:33:38: “Find me 1 accredited school that has opened up in the last 10 years, internationally that educates DCs according to straight/subluxation-based chiropractic philosophy.”

I would venture that the new schools are *pretending* to have dropped the subluxation concept. For example, let’s take the first one of your list – Spain. Here’s what the Barcelona College of Chiropractic (BCC) says on its website:

Quote
“Consistent with chiropractic principles and theory, the BCC team has aimed to develop a curriculum that combines the study of basic and clinical sciences with a deep reflection on the body’s innate ability to optimise its own health potential.”http://www.bcchiropractic.es/eng/estudios/estudios.htm

To me, that looks like deliberate language distortion concealing a vitalistic agenda.

As for the last country on your list, South Korea, I understand that its law states that chiropractors can’t practice their techniques unless they’re qualified MDs. Please correct me if I’m wrong.

NMS-DC wrote on 15 November 2011 at 03:33:38: “Let’s talk about trends, BW, if you’ll indulge me. Is the trend towards EBM chiropractic or subluxation-based chiropractic, in terms of education and research. These are relevant matters to our conversation. Please provide citations for your answer as like Harriett said, anecdotes are worthless here.”

I don’t think the trend is towards EBM chiropractic or subluxation-based chiropractic. I think the trend is towards chiropractic’s few useful techniques being absorbed by other NMS providers. For example, as noted above, U.S. chiropractors are staring the following in the face:

Quote
“Doctors of physical therapy (DPTs) are being positioned as the providers of musculoskeletal care, including diagnosis and manipulation. If DCs agree to be limited to caring for patients with musculoskeletal disorders, they can anticipate having the rug pulled out from under them by DPTs.”http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=55623

In addition to that, as you are no doubt aware, the Swedish Agency for Higher Education recently released a report regarding the education for chiropractors. Interestingly, it recommended that the Swedish government should make chiropractic a specialty of physiotherapy. All things considered, that seems the most sensible way forward for chiropractic on an international scale.

I can’t help but notice that NMS-DC has completely failed to respond to the observations that Googling for chiropractors in Boston and Chicago failed to turn up A SINGLE ONE that EITHER rejects the subluxation OR limits themselves to MSK. Let’s do it again – new day, new city. Let’s try Dallas this time.

I won’t do the full breakdown again, because it’s all the same. Suffice it to say that the entire first page of results was examined. I found ONE who didn’t make explicit claims to treat non-MSK conditions. And two who did not explicitly base their practice on subluxations or an equivalent term. Which did not include the first, and without some such concept it’s hard to see how spinal adjustment could have an effect on allergies, for instance.

So out of three cities, we’ve found a single chiropractor who limits their practice to back pain, and even that one is subluxation-based.

#2 offers accupunture, massage and naturopathy. This is actually a major hospital in our area.

#3 a DO that does none other than spinal manipulation.

Hmmmm interesting! A myopic viewpoint one could say.

@ scott

“One could speculate that it might be that those chiropractors who embrace subluxations and believe they can treat a wide range of conditions are more likely to have websites, and/or those websites are more likely to be highly ranked in Google. This would be one of those possible biases I mentioned.”

Exactly.

Suppose that one is a patient looking for chiropractic care. These days, what will likely be the first thing you do? Google for a chiropractor in your area, that’s what. So even if this is a non-representative sample, it’s the non-representative sample to which patients are most likely to gravitate. It is therefore inappropriate to claim that this represents a minority and hence is not an issue. That would merely adjust what TYPE of issue it is.

This is your opinion and I have a differing opinion. People do not find their medical professionals on google. They ask their pcp, friends, family and acquaintances. When was the last time you took to the internet to find a competent doctor? So no, this is just a non-representative sample that only very few people gravitate to.

What exactly is the point of your MD search? Leaving aside entirely the fact that most MDs are part of a larger organization and lack their own web pages (not true of chiropractors), the point at hand is whether in fact the bulk of chiropractors reject the subluxation and restrict their practice to MSK conditions as NMS-DC claims.

When was the last time you took to the internet to find a competent doctor?

Three times in the past month, in fact.

They ask their pcp, friends, family and acquaintances.

Given that most people (wisely) don’t frequent chiropractors, and no responsible PCP would refer a patient to them, that doesn’t exactly work as a counterargument.

I also observe that you’ve signally failed to provide any rationale for why the supposed majority of chiropractors who practice science-based chiropractic don’t have webpages while the supposed minority who embrace subluxations and treat allergies do. All you’ve got is a tu quoque on an irrelevant point, and an objection to an ancillary point. No response at all to the central problem.

To show how ridiculous your argument is. You can find anything on google. You are on a science based medicine website and you are using google searches as your evidence. This is homeopathy level evidence (as nybgrus would say). Furthermore, your whole argument is based on an assumption that the public uses google to find their doctor. Any evidence for your assumption?

The best-quality evidence is that Jann presented in the post. I freely admit, as mentioned earlier, that this is a crude methodology. Nevertheless, you don’t seem to be able to provide any explanation for why the results are incorrect. (Note that observing that a given bias is POSSIBLE doesn’t so demonstrate; you must also provide some evidence that it ACTUALLY DID bias the results.)

The evidence for the assumption that people Google for doctors in general, and chiropractors specifically, is based on seeing many people around me do exactly that. But let’s not get sidetracked on that. It only becomes relevant, as I said, if you are able to successfully argue that the sampling is massively biased.

Can you, or can you not, refute the conclusion that these results suggest that the great majority of practicing chiropractors embrace the subluxation concept and claim to treat diverse conditions such as allergies, colic, bed wetting, and ADHD?

Some of this well-done observation of chiropractic behavior is directly and some indirectly applicable to this discussion.
There is no subluxation/manipulable lesion/joint disfunction science. There are some patients with mechanical back pain, some with nerve root impingement and more serious concerns, even pathologic fractures. Some have significant psychosocial issues: lawsuits or disability claims, associated depression. Some are in need of physical conditioning.
The chiropractic core treatment ethos of spinal manipulation is a modality which does not put anything back in place or reduce subluxations and it has precious little science behind it. In essence, some people report temporary subjective relief of discomfort following the clinical encounter and spinal mobilization. That is all there is to it. The rest is marketing, ideology, myth, and placebo. Treatment of conditions other than mechanical low back pain by chiropractors is seriously problematic, aided and abetted by clueless political concerns rather than science. Chiropractors are self-regulating, their educational system is self-accrediting, and they are outside the realm of usual professional scrutiny.
a. Never let them touch your neck. With no evidence of significant benefit beyond placebo from neck manipulation, no headache or somatic symptom is worth the risk of a vertebral artery dissection and stroke or possible death.
b. There is no evidence behind the attempts to promote “maintenance of spinal health” by repeated chiropractic treatment in asymptomatic individuals.
c. Any diagnoses by chiropractors beyond nonspecific regional back pain or sprain are unlikely to be reality-based.
d. Chiropractic treatment for all of those other conditions listed in comments here: eneuresis, autism, otitis media, constipation, high blood pressure, headaches, etc. should be avoided as unnecessary, useless, and delaying of possibly appropriate diagnosis and care.

Is that a touch of resentment JPZ? I really don’t wish to engender that in you.

But just like the chiros here, much of what you have presented as of late (which I would assume is the cause of your current resentment) has been basic sciences stuff. The point is that simply just doesn’t translate to clinical scenarios (with relatively rare exceptions). The difference is that what you present actually is pertinent to the conversation and you are very sincere and quite good at being very scientific in your argumentation. I think the only rift betwixt us is the current (minor, I think) basic sciences-to-clinical-sciences issue.

Scott “I also observe that you’ve signally failed to provide any rationale for why the supposed majority of chiropractors who practice science-based chiropractic don’t have webpages while the supposed minority who embrace subluxations and treat allergies do”

I’m just speculating based on my experience working with marketing folks, but it would make sense to me that more quackish individuals from any of the healthcare professions would be better represented on the web. A quack’s main focus is on marketability, so they are going to select therapeutic methods based on marketability and expanding market share (not evidence of actual benefit) AND they are going to market themselves more aggressively, therefore get more hits or pay for feature spots on google.*

In my experience the professionals that are very evidence and fact based, generally don’t focus on marketing as much or at all.

This is purely anecdotal, but maybe there’s enough tendency in either direction to slant google results.

*Not sure if that makes sense. My son had surgery yesterday, So I’m in a lack of sleep fog. But I’m always fascinated with figuring out factors that might skew search results, so I couldn’t pass up the chance to speculate.

Scott, “I have a hard time seeing that as enough of a bias to almost completely exclude what NMS-DC claims is the great majority of chiropractors.”

Yup, could be, but google isn’t designed to give you any sort of representative sample. I would think a way to get a more accurate idea in a particular area would be to look up yellow page standard listings, then call randomly selected offices posing as a potential patient (or all offices, depending upon number of listings) with a standardized questionnaire. Or maybe just one question, like “do you do cranio-sacral therapy?”

MicheleinMichigan: A similar study was published in Skeptical Inquirer about 3 years ago by Bruce Thyer and Gary Whittenberger of FSU. Thyer called chiro offices in Tallahassee and in St. Petersburg/Tampa area and identified himself as a patient with high blood pressure and/or some other medical condition. He inquired whether the chiropractor would/could treat such. As I recall, about half of the offices said they could, about a fourth said “come on in and we will see” and most calls were answered by a receptionist. The receptionist often seemed to check with the chiropractor before answering.